title: Diagnosis of dystocia and management with cesarean section among primiparous women in Ottawa-Carleton.
abstract: We carried out a chart review study to determine the rate of diagnosis of dystocia (abnormal progress) and the use of cesarean section to treat dystocia among 3887 primiparous women who gave birth to a single baby in the vertex presentation at four hospitals in Ottawa-Carleton in 1984. Of the 3740 women who had some labour 1127 (30.1%) were given a diagnosis of dystocia. Cesarean section for dystocia was done during all phases of labour (41% of procedures in the latent phase, 38% in the active phase and 21% in the second stage). The cesarean section rate varied among the hospitals from 11.8% to 19.6%. A total of 75% of the cesarean sections were for dystocia, disproportion or failed induction. The findings suggest that cesarean section is being done for disproportion without a trial of labour beyond the latent phase and for dystocia in the absence of fetal distress. If these practices were modified the cesarean section rate could be reduced from 16% to about 8%, the rate found in some other centres and that observed in Canada in the early 1970s.
authors.affiliation: Department of Epidemiology and Community Medicine, University of Ottawa, Ont.
authors.forename: P J
authors.initials: PJ
authors.lastname: Stewart
authors.forename: C
authors.initials: C
authors.lastname: Dulberg
authors.forename: A C
authors.initials: AC
authors.lastname: Arnill
authors.forename: T
authors.initials: T
authors.lastname: Elmslie
authors.forename: P F
authors.initials: PF
authors.lastname: Hall
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D004420:Dystocia / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced; D009864:Ontario; D010298:Parity; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011247:Pregnancy; D014219:Trial of Labor